The Relationship Between the Self and The World in Psychotherapy for Psychosis: Contributions From a Metacognitive Approach

Henri Grivois has posited that psychosis involves the subjective experience of oneself as the center or focal point of the world. In this experience, the world that is typically unrelated to oneself becomes incomprehensible, and in its place is the sense that all life events are directly related to oneself or that one is perpetually at the center of all noteworthy activity. We suggest that this experience of centrality can be understood through the lens of the integrated model of metacognition. Specifically, we explore the idea that the metacognitive domain of decentration, or the ability to form ideas about the larger community one is a part of, can be used to operationalize and measure centrality. We propose a three-phase approach to addressing centrality within an integrative psychotherapy focused on subjective and experiential aspects of recovery. These phases focus on the patient's experience of centrality and include (1) inviting the therapist to join one's centrality, (2) acknowledging others as different from oneself, and (3) recognizing alternative perspectives in the world. We provide case examples and explore the metacognitive tasks and potential barriers associated with each phase.